Overview
- Guidance dated Nov. 6 and shared with consulates tells officers to consider conditions such as cardiovascular and respiratory disease, cancer, diabetes, metabolic and neurological disorders, mental health conditions, and obesity if they foresee costly or prolonged treatment.
- The directive applies to immigrant visas and many temporary categories, including H‑1B, with explicit exemptions for humanitarian applicants such as refugees and asylees.
- Consular officers are directed to weigh factors like age, dependents, prior use of public benefits, English proficiency, financial resources, and potential long-term institutionalization when evaluating likelihood of becoming a public charge.
- The State Department defends the approach as enforcing long-standing self-sufficiency principles and protecting taxpayers, with spokesperson Tommy Pigott emphasizing prevention of public medical costs.
- Medical experts and legal advocates warn the policy was issued without customary technical review, note officers lack medical training, and caution that broad discretion could lead to subjective or discriminatory outcomes.